Abstract: FR-PO1026
Medicaid and Dual Eligibility Are Negatively Associated with Kidney Function Recovery in Patients with AKI Receiving Outpatient Dialysis
Session Information
- Social, Environmental, and Economic Determinants of Kidney Health
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Babroudi, Seda, Tufts Medical Center, Boston, Massachusetts, United States
- Tighiouart, Hocine, Tufts Medical Center Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, United States
- Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
- Neyra, Javier A., UAB Hospital, Birmingham, Alabama, United States
- Sanders, Ronald, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Manley, Harold, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
- Drew, David A., Tufts Medical Center, Boston, Massachusetts, United States
Background
Access and quality of social risk data in patients with acute kidney injury receiving outpatient dialysis (AKI-D) are severely limited. However, Medicare-Medicaid dual eligibility status is an indicator of social risk and has been previously associated with worse dialysis outcomes among maintenance hemodialysis patients. We sought to explore the relationship of insurance status at baseline with kidney function recovery among patients with AKI-D.
Methods
Using a multi-center retrospective cohort design, we evaluated the association of insurance status at baseline with kidney function recovery to dialysis independence among patients with AKI-D who initiated hemodialysis between 2017 and 2021 at a medium-sized dialysis provider. We used Cox proportional hazard models adjusting for demographics, comorbidities, hemodialysis characteristics previously associated with recovery, and other social risk factors (modified area deprivation index, rurality of primary residence).
Results
Among 2,544 patients with AKI-D across 238 dialysis facilities, mean (SD) age was 65 (14) years, 58% were men, and 19% were Black. The most common primary insurer was Medicare/Medicare Advantage/Veterans Affairs (47%), with 17% dual eligible, and 12% insured with Medicaid. 857 (34%) patients recovered kidney function with a median (IQR) follow-up time of 103 (28, 180) days from first outpatient hemodialysis session. Medicaid and dual eligibility negatively associated with kidney function recovery when compared to Medicare/Medicare Advantage/Veteran Affairs as the primary insurer, even after multivariable adjustment (aHR 0.54, 95% CI 0.34, 0.84; aHR 0.67, 95% CI 0.47, 0.95, respectively) (Table 1).
Conclusion
Medicaid and dual eligible status negatively associated with kidney function recovery among patients with AKI-D, suggesting a role for upstream socioeconomic factors associated with insurance coverage to be used in future research exploring health disparities and shaping health policy in this population.
Funding
- Other NIH Support